Flint Rash Investigation

Assessment of Chemical Exposures (ACE) Investigations - FY2015 Q3 Burden Report

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0923-0051 can be found here:

Documents and Forms

Document Name Document Type
Flint Rash Investigation Form and Instruction
Follow-Up Flint Rash Dermatology Report Form Att B Flint Rash Dermatology Follow-up Report Form.docx Form and Instruction
Att A MDHHS Derm Follow up assistance request 0419-2016.pdf Letter of Invitation IC Document
SSB ACE Invstg Flint Rash Drmtlgy Fllw-up.docx Supporting Statement B IC Document
Att C Flint Rash Dermatology Follow-up RDF Signed.pdf Research Determination IC Document
Request ACE Investsgtn Form_Flint Rash Follow-up.pdf 0923-0051 GenIC Request IC Document

Information Collection (IC) Details

IC Title:	Flint Rash Investigation	Agency IC Tracking Number:	16AEB

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NA	Follow-Up Flint Rash Dermatology Report Form	Att B Flint Rash Dermatology Follow-up Report Form.docx	NA	No		Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title: 09-19-0001 Record of Persons Exposed or Potentially Exposed to Toxic or Hazardous Substances	FR Citation: 76 FR 4432

Number of Respondents: 150	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Letter of Invitation	Att A MDHHS Derm Follow up assistance request 0419-2016.pdf	04/19/2016
Supporting Statement B	SSB ACE Invstg Flint Rash Drmtlgy Fllw-up.docx	04/19/2016
Research Determination	Att C Flint Rash Dermatology Follow-up RDF Signed.pdf	04/19/2016
0923-0051 GenIC Request	Request ACE Investsgtn Form_Flint Rash Follow-up.pdf	04/19/2016

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.